Section III Applications

Chapter
Educational implications of

18 executive dysfunction
Lisa A. Jacobson and E. Mark Mahone

As has been discussed throughout this volume, EF is a broad term describing the range of
skills required for purposeful, goal-directed activity, socially appropriate conduct, and
independent regulation of action and affect.1,2 EF skills can be considered a “domain of
neurocognitive competence”1 that sets the stage for learning, academic achievement, and
rule-governed behavioral functioning. In practical terms, EF involves developing and
implementing an approach to performing a task that has not been habitually performed.3
When skills become overlearned through practice and thus automatized, they require less
executive or “top-down” control.
In performance-based activities, implementation of EF occurs after perception but
before action, thus involving a preparedness to respond.4 The central components of EF
are those that facilitate a “pause” that occurs after perception but before action, that allows
for appropriate response preparation. These components include response inhibition,
attention regulation, WM, and planning.5 Expanded definitions of EF also include problem
solving skills, organization of behavior, mental flexibility, set-shifting, and the capacity to
delay gratification.2,6 These sub-components are considered separable from the specific
cognitive domains and modalities in which they are assessed, but are nevertheless crucial to
performance, and critical for remediation of learning difficulties of all kinds.4
Terminology for these fundamental skills often varies as a function of discipline-specific
literature. For example, the developmental psychology literature refers to these skills as self-
regulation and/or effortful control, although assessment of these skills has often relied upon
measures tapping very similar types of skills (e.g., inhibition, cognitive control, WM) within
cognitive, behavioral, affective, and/or temperamental domains.
EF skills required for the cognitive control of behavior and affect show a protracted (but
uneven) developmental trajectory (see Chapters 2 and 3 in this volume for a more detailed
discussion of this developmental process). These skills develop throughout childhood and
into young adulthood, concurrent with the development of neural synapses, myelination of
brain regions, and recruitment and consolidation of neural networks.7,8 During early
childhood, the internalization of standards, the ability to delay gratification, and behavioral
and cognitive self-regulatory skills are consolidated and applied to learning and social
situations.9,10 The preschool years provide a critical window in the development of founda-
tional EF skills during the period of rapid neurological, cognitive, and social-behavioral
growth.11 Although various EF skills show different growth rates and trajectories through-
out development, many skills emerge by early childhood.12,13 These include planning and

Executive Function and Dysfunction, ed. Scott J. Hunter and Elizabeth P. Sparrow. Published by
Cambridge University Press. © Cambridge University Press 2012.
232
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 Chapter 18: Educational implications of EdF 233

problem solving,14 sustained attention,15 inhibition or switching attention,16,17 and self-

regulation for compliance.18 Thus, core EF skills such as planning, attentional control, and
behavioral self-regulation are evident as early as the pre-school years, with improvement
and refinement in these skills throughout childhood and into adulthood.19

Contributions to outcomes
Deficits or delays in attaining core EF skills can interfere with a child’s ability to successfully
manage and complete daily tasks and to navigate social interactions. EdF puts children at risk
for ineffective interactions with the environment, leading to significant and lasting cognitive,
academic, and social difficulties.20,21 Problem solving and planning skills are necessary for self-
regulation of behavior and affect and for negotiating social interactions where understanding
others’ behavior in context and responding appropriately becomes important.13 Not surpris-
ingly then, problems with developing early competence in executive control have been shown
to predict children’s social problems, with later EF predictive of a variety of psychosocial
outcomes in adolescents.22,23 Similarly, difficulty with behavioral self-regulation may result in
a child’s failure to develop important social competencies, including compliance with requests,
delaying gratification, and managing appropriate behavior in social and educational settings –
all skills required for successful school entry.24 Additionally, deficits in early foundational self-
regulatory behaviors may compromise later development of social and behavioral problem-
solving skills by significantly impeding academic, adaptive, and social competence.25,26
Readiness and availability for learning. EF skills represent an important prerequisite for
learning, and provide the cognitive, affective, and behavioral foundation for a student’s
readiness (globally) and availability (moment-to-moment) for learning. Early school readi-
ness includes not just knowledge of basic pre-academic concepts, but also the ability to
behave as a learner. Kindergarten and first grade students are expected to listen attentively, sit
still when required, take turns, follow directions, get along with others, and inhibit impulsive
actions or irrelevant responses. Early behavioral dysregulation can significantly affect chil-
dren’s functioning during the transition into formal schooling.27 Data from a national
sample of kindergarten teachers indicate that many of the children entering school do not
have adequate “learning to learn” skills and show behavioral regulation problems that
substantially limit their availability for early learning.28 In fact, one study found that
children’s cooperation and self-control significantly predicted kindergarten retention rates.29
According to teachers, work-related skills such as compliance with directives and listening to
instructions were considered the most important skills for kindergarten success, even above
pre-academic skills,30 and can be considered to set the stage for future academic success.
Behavioral regulation. Early behavioral regulation in the classroom has been shown to
predict a variety of later school-related behavioral outcomes, including social interaction
skills and interpersonal behavior,31 as well as academic and work-related behaviors.32,33 For
example, at the kindergarten level, children’s performance on tasks requiring inhibition,
cognitive control, and emotional self-regulation at school entry significantly predicted
teachers’ reports of children’s behavioral self-control, cognitive self-control, and work
habits in the spring of the kindergarten year.34 Blair and Diamond35 suggested that children
who begin school with EdF are at risk for experiencing a “negative feedback loop,” in which
difficulty with tasks and poor interactions with others lead to changes in self-concept and
levels of arousal, which in turn impact cognitive and affective control. These changes reduce
children’s motivation and investment in the academic process, increase their resistance to

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 234 Section III: Applications

school, increase the potential for dropout, and may contribute to the increasing achieve-
ment gap between children with and without adequate EF skills.35
Cognitive control. Sustained attention and inhibition of impulsive responding have been
shown to predict children’s cognitive functioning and academic achievement.36 These skills
are important developmentally because academic success depends upon the ability to stay
with a task long enough to complete it while avoiding distractions.37 Not surprisingly,
inhibitory control and WM in particular have been shown to be critical to young children’s
intellectual development38 and academic success.39 In very young children, early EdF,
within the context of otherwise typical cognitive development, has been hypothesized as a
marker of increased risk for early developing psychopathology and LD.40
Early EF skills have been shown to predict not only school readiness, but also later
academic success.41,42 For example, early work-related skills assessed at the start of kinder-
garten predicted reading and math skills during kindergarten and beyond.43 More broadly,
skills involved in executive control are positively correlated with children’s academic achieve-
ment scores, teacher-rated competence, and academic grades.44,45 In fact, early EF skills
assessed prior to school entry have been shown to predict academic success and psychosocial
functioning during the transition into middle school.33 Specifically, inhibition, effortful
control, and nonverbal problem solving skills predict mathematics achievement in kinder-
garten and beyond. Inhibition made the strongest contribution to early math abilities, while
set-shifting, WM, and problem solving all contributed to achievement of later (more concep-
tually complex) math skills.41,46,47 Spatial WM in particular has been shown to relate to
children’s early counting ability48 and to mathematics achievement as late as middle school.49
EF skills have also been implicated in the development of language-related academic
skills, including reading (decoding, fluency, comprehension) and written expression.47,50
For example, WM, inhibition, and planning are associated not only with pre-reading skills
in preschool, but also with reading achievement in later elementary school years.41 In
particular, WM and planning have also been shown to be uniquely associated with reading
comprehension (over and above the contributions of vocabulary, decoding and reading
fluency) in school-aged children,51 suggesting a link between EdF and late-onset
reading comprehension difficulties among children who may not present initially with
deficits in basic word decoding skills.52,53
Processing speed. Children who struggle to meet these increasingly complex classroom
demands are at greater risk of being identified by teachers and even parents as “lazy” or
“unmotivated,” particularly when they are slower to complete their work or require
additional time to complete tasks.62 In fact, there is increasing evidence that children with
EdF may actually require more time to complete tasks; cognitive processing speed is
significantly slower for many children who demonstrate EdF.63 As a result, slowed process-
ing of incoming information can cause affected children to miss aspects of classroom
instruction, limiting their capacity to respond to additional incoming information, and
delaying their ability to generate a reasonable approach to tasks and events. Furthermore,
processing speed influences the efficiency of other academic tasks, including reading
fluency64 as well as more complex tasks such as reading comprehension. For example,
children with ADHD tend to show slower reading fluency compared to controls even in the
absence of comorbid reading or language disorders.63,65 These children, although less likely
to present with overt behavioral problems, are apt to forget quickly and thus struggle with
multiple aspects of classroom functioning related to both implementation of procedures
and acquisition of specific academic skills.

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 Chapter 18: Educational implications of EdF 235

Social functioning. Finally, as children progress through school, the complexity of their
social interactions increases. Social exchanges demand not only more inferential language
and nonverbal communication skills, but also the ability to regulate affect and behavior to
meet the demands of the situation. For many children, social interactions that take place
within the classroom or broader school setting can be especially challenging. These
exchanges may involve some type of conflict, whether teasing, power-struggles, or explicit
aggression, circumstances which require the child to regulate emotions, inhibit immediate
actions and reactions in order to comply with school expectations and rules, and initiate
other methods for dealing with their peers as well as their own reactions. Such situations
place a high demand on aspects of EF that some have labeled “hot EF;” these are circuits
linking medial and orbital frontal regions with other brain areas (see Chapters 1 and 3).
These circuits have been specifically implicated in decision-making under emotionally
salient conditions.66 There is a growing body of work suggesting that EF is a product of
complex orchestration of regions in the brain that also process emotion and affective
responses to social cues.67,68 Not surprisingly, EF has been strongly linked to social behav-
ioral problems and psychopathology in children.33,69

Executive functions in school

The child–environment interaction. Development of EF occurs within a complex environ-
mental context (see Chapters 2 and 3). Given the prolonged period of postnatal development
and maturation of these skills, EF may be especially sensitive to environmental influences.5,54
The frontostriatal brain systems that support EF have a protracted period of development –
and are vulnerable to disruption through a variety of etiologies – which may be why so many
children referred clinically present with concerns involving EdF.55 Accordingly, functional
academic difficulties related to EdF may be observed immediately, or, more often across time,
such that the full range of functional deficits may not manifest until later in life even though
the neurobiological basis of the condition is present earlier (see Chapter 19).56
Environmental factors that potentially influence EF development include family SES,
parenting styles, parental language competence, and genetic influences,57,58 among others.
Multiple school factors also play an important role in supporting the development of EF
skills. The elementary school setting demands an increasingly complex array of executive
skills from children, including attentional regulation (i.e., attending to instruction and
ignoring distractions), inhibition of impulsive responding, verbal WM (i.e., multi-tasking
or remembering multistep instructions), and task approach skills (i.e., determining how to
initiate a task or to break more complex tasks into manageable pieces). At the same time,
contextual supports for executive control of behavior are typically reduced in later elemen-
tary years, leading to a mismatch in some students between skill development and environ-
mental demands.59 As such, the role of the teacher becomes critical in structuring the
classroom, setting daily routines, and providing lessons in a manner that maximizes each
child’s availability for learning by reducing extraneous EF demands (e.g., multitasking,
speeded activities, taking notes from lectures).60
Early elementary years. Even in the early elementary grades, certain academic tasks place a
high demand on children’s developing EF skills. There are particularly heavy demands for
inhibition and WM, not only for “readiness” and “availability” behaviors, but also in the actual
acquisition of early reading and mathematics skills. In the early grades, academic success is
based on concrete, rote learning of new information and skills that become automatized over

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 236 Section III: Applications

time through repetition and practice. Examples include learning the alphabet, sound–symbol
relationships, sight words, letter formation, and math facts. As children progress through
school, learning becomes more integrative. Children are asked to arrange single words (using
rules) to make sentences and paragraphs and to apply basic math facts to solve long division
problems. By third and fourth grade, instruction shifts from a “learning to read” model to a
model requiring application and integration of prior knowledge (“reading to learn”). By
fourth grade, assignments routinely require multiple steps, narrative responses, integrating of
oral language and writing, and inferential (“beyond the text”) thinking.61 Unlike texts for
beginning readers, fourth grade textbooks typically rely on expository language, with no
explicit template to aid comprehension and recall. These more complex reading comprehen-
sion assignments place an increased demand on children’s developing EF skills, especially
verbal WM, which facilitates holding information in mind long enough to complete the
passage, recall the main idea or relevant information, and answer related questions. Further,
by fourth grade, poor reading fluency can increase demands on other cognitive processes (e.g.,
WM), leading to a competition with word decoding for time-limited resources, thus creating a
bottleneck that is associated with rapid forgetting. Writing tasks also increase in complexity by
the end of elementary school, as longer essay-type assignments require not only WM, but also
organization, self-monitoring, and problem solving.
Late elementary years. As children reach upper elementary grades, expectations increase
sharply for independent management of materials, assignments, work completion, and
belongings. The structure of the classroom in the primary grades is often explicitly designed
to support children’s developing ability to transition smoothly between activities and
events: teachers provide clear advance warning of upcoming transitions, give specific
reminders of expected behavior, and anticipate areas of difficulty and plan accordingly.
Often, these behavioral strategies are accompanied by concrete language, single-step direc-
tions, wait time between tasks, and assistance as needed. All these supports serve to reduce
concurrent EF demands and increase students’ readiness. By later elementary school,
however, academic demands predominate and classrooms are structured in such a way as
to increase the executive demands placed on children. For example, academic tasks increase
in complexity; longer assignments must be completed in shorter amounts of time; assign-
ments require more lengthy written output; multiple small groups may take place within the
same classroom; lessons involve fewer hands-on materials and greater reliance on a lecture
format; instructions frequently consist of multiple steps involving a variety of materials; and
multiple transitions across the day take children outside of the classroom.
Furthermore, children are expected to independently monitor their progress on tasks
relative to the time remaining, remember to turn in their completed homework, remember
to copy the next homework assignment, and plan ahead to collect materials needed to
complete upcoming homework. At the same time, expectations in the upper elementary
grades and beyond often include the ability to appropriately begin, plan for, and carry out
longer-term projects involving multiple steps. Such projects require initiation, problem
solving, segmentation (breaking complex tasks into component parts), generating ideas,
identifying an efficient approach, and carrying out the plan in a logical order. All of these
demands rely heavily on children’s EF skills and place children who enter school with EdF
at significant risk for diminished academic achievement and negative school outcomes.
Middle school transition. EF skills continue to play an important role in successful
academic and social functioning as children progress beyond the primary grades. As
academic expectations increase, some children can experience a “regression” in

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 Chapter 18: Educational implications of EdF 237

self-regulation during early adolescence.67 Increases in behavioral dysregulation during early

adolescence are seen particularly in children at greatest risk for EdF.70 At the same time as
this developmental dysregulation, most children transition from an elementary school
setting into a middle or junior high school setting, adding increasing demands on their
still-developing EF skills.71 The transition into middle school involves a physical change of
location, changes in school perspective and instructional formats, increases in the number of
different teachers, decreases in perceived teacher support, increases in class size, changes in
peer networks, increased expectations for individual responsibility, and increased exposure
to the potential for delinquent behavior.72,73 Each of these new challenges places increasing
demands on the child’s developing EF skills, as the increased workload, class changes, and
larger peer groups require greater self-regulation and WM than were required in an
elementary school setting.74 The changes in expectations and responsibilities at sixth grade
are more apparent for those students who make a school transition than for those who
remain in an extended elementary school; thus, self-regulation and other EF skills may play
more of a role in their academic and social competence.33,73
Most students do navigate this transition successfully;75 however, some children
experience substantially greater difficulty, resulting in decreased self-worth, increased
psychological distress, and increased school disengagement, as well as increased involve-
ment in potentially risky behavior.76,77 Stressful transitions to middle school can have long-
term consequences, with greater negative impact on low-achieving children and children
already at risk due to social factors.77,78 For these children, this transition can produce
significant reductions in achievement and effort and increases in behavioral and social–
emotional problems.78,79 African American students in particular have tended to experience
greater declines in grades following the transition to middle school, compared with children
from other ethnic groups.80,81 Low-achieving students and those with LD tend to show
more negative effects of transition to middle schools than higher achieving students.82
Thus, the middle school transition can significantly impact children’s adjustment and
academic outcomes, with this transition posing even greater challenges to children already
at risk for poor outcomes.
The ability to successfully manage the middle school transition depends on multiple
factors, including personal maturity and coping skills, characteristics of the new school
environment, and the level of preparation and social support available to the student both
before and after the transition.83 Individual coping skills include the ability to solve
problems effectively and demonstrate self-control within a variety of classroom and social
situations: in other words, intact EF. For example, children with ADHD84 show an increase
in parent reports of problem behaviors70 following their transition into middle school.
Given these findings, it is critical to consider the level of support provided to children
during important school transitions, as well as following specific shifts in developmental
expectations (e.g., mid-elementary school, etc.). The level and quality of support available to
children prior to and during these transitions has the potential to significantly improve
children’s functioning.

School-based intervention
There are significant implications for children entering school without the self-regulatory
and executive control skills needed to function competently and learn productively within
the school setting.28 Although most children learn and develop these skills over the course

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 238 Section III: Applications

of elementary school, EdF persists in many children and contributes to less successful
academic and social outcomes. There are a variety of classroom-based strategies that have
been employed to address young students’ social and emotional competence, which there-
fore have implications for improving EF. Unfortunately, fewer interventions have been
examined for supporting children within the upper elementary grades and beyond. Strat-
egies that have been proposed include improving the quality of instruction, strengthening
teacher–student interactions, developing curricula targeting development of specific social
and behavioral regulation skills, implementing individualized instruction to address par-
ticular children’s needs, and providing problem-focused and skill-based strategy coaching
in the schools. Proposed interventions vary in their focus; however, each shows promise for
supporting development of the EF skills shown to be critical for school readiness, academic
performance, and later life success.
Current educational policy (e.g., the reauthorization of IDEA and “No Child Left
Behind”) focuses on improving teacher quality broadly, emphasizing teacher pre-service
training and educational qualifications. Proximal measures of classroom quality, including
measures of the quality of specific teacher–child interactions and the use of specific
instructional pedagogy and management strategies, have been shown to substantially affect
children’s academic and behavioral functioning.85 For example, children in kindergarten
classrooms in which teachers used proactive approaches to classroom management and a
variety of instructional strategies demonstrated better behavioral and cognitive self-control
in the spring of the kindergarten year and were observed to be more engaged in learning
activities throughout the school year, compared with children in classrooms with teachers
who used less proactive approaches.34
For children deemed most at-risk for early academic and behavioral dysfunction, high
levels of instructional and emotional support within the classroom have been shown to
result in less behavioral dysregulation and better academic outcomes.85,86,87 Consistent
with these findings regarding teacher practices, individualized student-focused instruction
and consistent use of student-focused planning was found to improve self-regulation skills
in children initially showing poorer inhibitory skills prior to the intervention.88 These
studies suggest that children’s learning and behavioral regulation skills are fostered in
classrooms where teachers provide coherent, consistent, and caring structure, including
well-planned activities, proactive behavior management strategies, clear organization of
transitions, individualized instructional feedback, and individualized interactions with
students. It is very likely that the mechanisms involved in these associations relate to
teachers’ use of proactive behavior management strategies within a warm and caring
environment that explicitly support children’s developing EF skills and self-regulatory
capabilities.
Large-scale problem-focused interventions have been evaluated for supporting develop-
ment of behavioral self-regulation in children specifically identified as at-risk for behavioral
and emotional problems. The Chicago School Readiness Project89 was designed to improve
teachers’ abilities to provide classroom instructional and emotional support to their stu-
dents through a combination of interventions used with children participating in Head
Start. (Note: In general, children participating in Head Start programs are at risk for
behavioral dysregulation and academic difficulty.) Teacher training and coaching were
combined with one-on-one, child-focused, mental health consultation for up to five chil-
dren per classroom, with a goal of improving teacher practices designed to support child
self-regulation in children at risk for academic and behavioral difficulty. Results of

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 Chapter 18: Educational implications of EdF 239

intent-to-treat analyses from this randomized clinical trial revealed that this combination of
supports resulted in substantial improvements in teacher responsiveness to individual
student needs, better classroom monitoring, more proactive prevention of misbehavior,
and less use of harsh or negative discipline practices.89 These findings suggest that such
environmental supports may better scaffold children’s developing executive skills.
The Rochester Child Resilience Project90 similarly targeted children at risk for social and
behavior problems who were enrolled in kindergarten through third grade. Interventions
involved up to 14 sessions with school-based mentors, including individualized skill-based
instruction addressing specific components of EF and reactivity (e.g., monitoring of emo-
tions, self-control, and emotion regulation). Additional support for classroom generaliza-
tion and practice was included. Children participating in the program were rated by their
teachers as showing improvements in behavior regulation, appropriately assertive behavior,
and on-task learning behaviors, as well as fewer disciplinary referrals and out-of-school
suspensions.90 A notable element of this program was its use of in-classroom mentoring to
provide opportunities for children to practice using specific self-regulatory skills within
emotionally charged situations as they arose.
With these strategies in mind, a number of preschool and elementary curricula have been
developed as universal prevention programs which focus on supporting development of
children’s self-regulation skills and executive control in order to promote early school
readiness skills and better academic outcomes. Examples include Promoting Alternative
Thinking Strategies (PATHS91), Tools of the Mind (Tools92,93), the Incredible Years Teacher
Classroom Management and Child Social and Emotion Curriculum (Incredible Years94,95),
I Can Problem Solve (ICPS96), and the Open Circle Program (OCP97). Empirical work examin-
ing these curricula has demonstrated that use of targeted instructional strategies has the
potential to improve children’s EF within the classroom setting. Although some of these
curricula explicitly focus on the self-regulatory skills considered to be critical to children’s
academic and social outcomes (e.g., PATHS, Tools, ICPS), others focus more broadly on
training teachers to use more effective classroom management strategies in order to prevent or
reduce problematic behavior and increase prosocial behavior (e.g., Incredible Years). In many
cases, even when the focus of the program is on student behaviors, there is a clear emphasis on
creating a positive, prosocial learning environment, involving some level of additional teacher
consultation or training. (Editor’s note: several of these intervention programs are also
discussed in Chapter 17, with regard to their broader use outside of the school environment.)
Tools of the Mind 92 is based upon Luria and Vygotsky’s theories of cognitive develop-
ment and emphasizes both behavioral regulation (e.g., social self-regulation and cognitive
control of attention and behavior) and specific academic skills within a framework of
activities designed to support children’s executive control. Use of the Tools curriculum in
preschool for one to two academic years was associated with better performance on
performance-based measures of inhibition as well as pre-reading skills.98 In a randomized
trial of the Tools curriculum, strategies designed to intentionally support development of
self-regulation of behavior and emotions through play were found to reduce both internal-
izing and externalizing behavior problems (as measured by teacher reports) and improve
performance on multiple measures of EF, with observations of teachers indicating improve-
ments in classroom organization/productivity and more sensitive instructional teacher-
child interactions.93,98
The PATHS curriculum91 is a universal school-based prevention curriculum designed
to reduce behavioral problems by promoting development of social–emotional and

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 240 Section III: Applications

self-regulatory competence. PATHS provides specific instruction across multiple social skill
domains through a developmental sequence spanning preschool through elementary school
ages, with a focus on emotional regulation, conscious strategies for self-control (e.g., verbal
mediation, inhibitory control), and supporting the child’s innate ability to solve social
problems effectively. In addition to specific lessons teaching self-control and social skills,
the program includes detailed extension activities and strategies for helping teachers create
an environment that promotes children’s learning of social-emotional skills. A randomized
trial of the preschool PATHS curriculum in Head Start classrooms found significant group
effects on children’s emotional knowledge and teacher-reported social competence, social
withdrawal, and anxiety, but failed to find specific group differences on performance-based
measures of inhibitory control, attention, or problem solving.99 In contrast, elementary
school-aged children in classrooms using the PATHS curriculum for one school year
demonstrated not only fewer teacher-reported internalizing and externalizing behavior
problems, but also improvements in performance-based measures of inhibitory control
and verbal categorical fluency, compared with children in control classrooms.100 Addition-
ally, in children identified as eligible for special education support, effects of PATHS on
externalizing and internalizing behaviors persisted at least 2 years after implementation of
the curriculum.101
The Open Circle Program (OCP97) is a classroom-based intervention program that
focuses primarily on improving social problem-solving and decision-making skills for early
elementary students through a combination of specific, skill-focused lessons and on-site
teacher consultation. Participation in the OCP during fourth grade was found to be
associated with better student social skills and fewer problem-behavior scores (compared
to fourth grade children in similar schools that did not implement OCP);102 children
attending school in urban areas showed the greatest gains. Similarly, middle school students
who had participated in OCP for at least two years of elementary school demonstrated
better social skills and interpersonal adjustment following their transition into middle
school (relative to children from schools not implementing this program).103 Although this
study was conducted by the curriculum’s creator, it is notable for its focus on the middle
school transition, a period that demands greater executive control and during which
difficulty is observed for many students (not only those with EdF) across both academic
and behavioral domains. The data suggest that interventions at the elementary school level
have the potential to scaffold development of the exact EF skills that are required for
successful transition into middle school.
Unlike the PATHS and Tools curricula, the Incredible Years curriculum was originally
designed for clinically referred children with early onset behavioral regulation difficul-
ties, and showed promise in improving these children’s problem behaviors across
settings.94 The original clinic-based model was adapted for use as a preventative pre-
school and early elementary universal intervention (the Dinosaur School curriculum).
The Incredible Years Dinosaur School preschool curriculum and the associated
teacher training in effective classroom management strategies and ways to promote
children’s executive control were found to result in significant improvements in emo-
tional self-regulation, distractibility, peer interaction skills, and child conduct problems.95
Follow-up evaluations of the program for children from low SES families who were at-
risk educationally and behaviorally revealed a significantly larger impact on school
readiness for students with greater initial difficulty with emotional and behavioral self-
regulation skills.

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 Chapter 18: Educational implications of EdF 241

Conclusions and implications for practice

EF involves a set of multidimensional skills that develop over a protracted period of time
and set the stage for academic, behavioral and social competencies that are crucial for
success in school and life. EF skills are founded on a complex cortico-striatal-thalamo-
cerebellar network that develops over time, with functional outcomes mediated (positively
and negatively) by environmental factors. EF skills are fundamental to the development of
competence in children, especially those who may be vulnerable as a function of poverty,
health problems, learning difficulty/LD, or societal stress. Attainment of appropriate EF skills
is critical for school success, and children who have EF delays or deficits are more prone to
learning difficulties, behavior problems, school withdrawal, and psychopathology. Despite
having intact intelligence, many children with EdF fail to adequately develop the requisite
skills to interact productively and effectively with the world. School-based interventions
appear to facilitate growth in children’s functional EF skills, and may ameliorate the risk in
those most vulnerable. Individuals working with children need a framework for approaching
EdF that includes an understanding of how the child’s physical and brain development
interacts with his/her environment and how these interactions change over time.
The most successful models and programs targeting EF development are those that
integrate knowledge from child development, neuroscience, psychology, and education.
Classroom teachers play a critical role in promoting EF skill development in children.
A challenge exists, however, because many of the classroom demands that exacerbate EdF
are hidden and not explicitly addressed. Such demands include the need for speed during
academic work, multi-tasking during class activities, simultaneous writing and listening,
and the challenge of an unpredictable school day. For example, while many middle and high
schools employ a rotating daily class schedule to avoid having certain classes consistently in
the afternoon (or morning), the inconsistency in daily schedules adds to the organizational
demands already inherent in the curriculum and can adversely affect children who are
vulnerable to organizational difficulties. A similar concern exists in using block scheduling
in which classes are taken only every other day. Despite the benefits, block scheduling also
places an additional organizational burden on students, in that they must spread homework
assignments over days without direct instruction.
Continued research and intervention in this area will require collaboration between
clinical researchers in the neurosciences, psychology, and education, with a goal of imple-
menting training in the understanding and treatment of EdF in teacher preparation pro-
grams. At the same time, core child clinical psychology training should include coursework to
facilitate a better understanding of the school setting and the issues facing children as they
navigate the academic, social, and behavioral demands within schools and classrooms.

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